INTRODUCTION
In western society the workplace is now the commonest cause of ill health. We have conquered many of the infections that used to afflict our ancestors but do not give the same attention to work related health issues. Health related issues are currently costing UK employers approximately £1000 per employee per annum. 187 million working days per year are lost to British business costing 12 billion pounds and every year UK trade Unions win hundreds of millions of pounds on behalf of their members who are injured at work!

Occupational Health is a specialty of medicine devoted to the study of the affects of our health on the work we are asked to do and the effect of that work on our health. This may be a relatively quick effect, for example developing a skin rash to something you work with, or a longer term effect, for example, developing a form of cancer many years after coming into contact with a particular substance.

The fact that the workplace can have a significant effect on your health has been known since the beginning of time. The Egyptians only sent slaves and criminals down into the mines because they were aware that people did not live long mining.

The first book of Occupation Medicine was published in the seventeenth century and this recorded many of the occupationally related conditions we see today, including Repetitive Strain Injury many centuries before computers!

It was the industrial revolution, however, that saw the need to treat and prevent diseases caused by working in the cotton mills, the mines, the match factories and many other industries that sprung up so quickly.

SO WHAT IS OCCUPATIONAL HEALTH?
Occupational Health is the specialty of medicine concerned with identifying and preventing ill health in the work place. It is also concerned with ensuring that there is nothing in an individual's medical history that will affect the way they work or put them at risk while at work. Occupational Health is therefore important at every stage of the work cycle, from recruitment to retirement.

YOUR EMPLOYEES ARE YOUR MOST VALUABLE ASSET
Employers quite rightly spend a significant percentage of the capital cost of a piece of machinery or computer software every year on its maintenance. The employees of any company, whatever the size, are the largest single investment for that company. Employee costs are much more than just the monthly salary. There are recruitment costs, training costs, annual leave and sickness costs and perhaps ill health retirement costs. Yet the majority of employers fail to make an effort to maintain their investment in their staff. We all expect the human body to go on day after day, year after year. Often working in a stressful of hazardous environment.

DO I NEED TO KNOW ABOUT THE LAW RELATING TO HEALTH AT WORK?
Occupational Medicine is unusual within medical specialties in that many of the examinations and procedures are linked to or required by UK or European Union laws. The Health and Safety at Work Act in 1974 set out the responsibilities of both employers and employees to ensure a safe and healthy working environment. There has subsequently been legislation covering noise, VDU screens, chemicals (COSHH regulations, CHIP regulations), the lifting and handling of loads, pregnancy, disability discrimination and night workers, to name a few subjects. No employer can ignore these laws or regulations as every workplace is included, even the self-employed. If the Health and Safety Executive inspectors consider an employer is not complying with the appropriate legislation large fines and prison sentences can result. This should concentrate the mind!

WHERE DO I START?
The basis of all Occupational Health and Health and Safety practice is the "Risk Assessment". This tool was introduced in the Health and Safety at Work Act in 1974 and developed through the1980's. The approach of the "Risk Assessment" is now standard and part of UK law with the introduction of the Management of Health and Safety at work Regulations in 1992.

Enough of the legal jargon! How does this all work in practice?

It is essential that the employer identifies all the significant hazards to his employees in the working environment. No working environment is completely safe. If there are no physical hazards there may be psychological ones, such as stress. A hazard is defined as the potential of a substance, a process or a situation to cause harm. A risk, however, is the probability of that harm occurring. We may be exposed to potentially dangerous situations on a regular basis, but because we approach them in a careful way the risk is minimal. For example crossing a busy road.

The Risk Assessment is a formal record, carried out by an individual who has been trained and has experience in this field. This process will recognize the risks, evaluate them and put in place measures to control or avoid them.

Part of this assessment process may involve Occupational Health doctors or nurses, who can carry out regular medical assessments to ensure the control procedures within the workplace are adequate and the employees' health is not being affected. This may take the form of a simple consultation or a more sophisticated medical test.

WHERE DO I GO FROM HERE?
A comprehensive Occupational Health Service can cost as little a 1% of a company's payroll costs per year. The savings in terms of reduced sickness absence, lower staff turnover, fewer accidents or claims against the company and improved staff morale, can be far more. Many Occupational Health initiatives are measurable.

Pre employment Assessments
To ensure that an individual is appropriate for a particular role a pre employment assessment can take the form of a clinical questionnaire or a full consultation and medical examination. When a potential employee unfortunately has a disability such an examination is essential to comply with the Disability Discrimination Act. Where there is a risk of a potential employee being exposed to a harmful substance or physical hazard this examination acts as a baseline for further in-service testing.

In-service Medical and Health Surveillance
If you have identified significant hazards within your workplace from your Risk Assessments, Health Surveillance may be required. This could be a clinical questionnaire sent to your employees at risk and reviewed by an Occupational Health nurse. It may involve a more detailed medical examination and a series of tests carried out on a regular basis.

Some positions require the employee to achieve a legal level of fitness and be assessed on a regular basis. For example, driving a Fork Lift Truck or a Heavy Goods Vehicle. Even office workers do not escape. If they use a computer on a regular basis they will require regular eye tests and training.

Executive Medical Examinations
Senior members of staff are particularly valuable to an organization. The loss of a key employee due to ill health may result in the loss of valuable business opportunities or contracts that have taken years to develop. It is much easier to replace plant or computers. Human beings require experience and training and regular medical examinations help to maintain an individual's health, confidence and loyalty.

Immunization Programs
Foreign Travel brings its own dangers and hazards. Occupational Health doctors and nurses are able to prepare employees for business travel and living abroad. This includes the latest information with regards to immunizations.

Problems often arise with staff returning from foreign travel or living abroad who contract tropical infections or who have difficulty acclimatizing to life in the UK on their return. Occupational Health staff can be available to support and help individuals through these issues.

Managing Employee Ill Health
Employee sickness can be very costly to any size of company and very disruptive for the employer. Occupational Health doctors and nurses are able to investigate each individual employee's case in a confidential and caring manner and provide managers with useful management information, with regards to how long a member of staff is likely to be absent and what safeguards should be put in place when they are fit to return to work. A member of staff may require regular medical assessment on their return. This can be done at work minimizing the time taken away from work to visit the doctor or hospital. In addition the return to work can be phased and supervised by the Occupational Health nurse or doctor.

Providing a safe and healthy working environment is a legal obligation for every employer. Investing in maintaining and protecting the health of your workforce is essential in today's fiercely competitive and fast moving business climate. The successful organizations have comprehensive Occupational Health and Health and Safety programs. This speaks for itself!